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Keeping the Deadly Malaria Infection Off Africa

Approximately 90% of all malaria deaths in the world today occur in Africa south of the Sahara.The continent is the most affected due to a mix factors: A very efficient mosquito (Anopheles gambiae complex) is responsible for high transmission. The prevalent parasite species is Plasmodium falciparum, which is the species that is most likely to cause severe malaria and death. People who have malaria usually feel very sick with a high fever and shaking chills.

[caption id="attachment_10938" align="aligncenter" width="300"] A sprayers’ team who just treated a house against mosquitoes is leaving for the next one on the Ruyaga hill, in Kinyinya health district. Burundi, September 2020. Photo: MSF[/caption]

Malaria a disease caused by Plasmodium parasites. The parasites are spread to people through the bites of infected female Anopheles mosquitoes, called "malaria vectors." A mosquito takes a blood meal from an infected human, taking in Plasmodia which are in the blood. The incubation period in most cases varies from 7 to 30 days. There are five (5) species of Plasmodium (single-celled parasites) can infect humans and cause illness:

  • Plasmodium falciparum (or P. falciparum);
  • Plasmodium malariae (or P. malariae);
  • Plasmodium vivax (or P. vivax);
  • Plasmodium ovale (or P. ovale);
  • Plasmodium knowlesi (or P. knowlesi).

However, two (2) of these species – P. falciparum and P. vivax – pose the greatest threat. WHO facts indicate that, P. falciparum accounted for 99.7% of estimated malaria cases in African in 2018 to 50% of cases in the World Health Organization (WHO) South-East Asia, 71% of cases in the Eastern Mediterranean and 65% in the Western Pacific.P. vivax is the predominant parasite in the Americas, representing 75% of malaria cases. Based on WHO's latest World malaria report, released on 30 November 2020, there were 229 million cases of malaria in 2019 compared to 228 million cases in 2018. The estimated number of malaria deaths stood at 409 000 in 2019, compared with 411 000 deaths in 2018.

Malaria transmission hinges on climatic situations that may affect the number and survival of mosquitoes, such as rainfall patterns, temperature and humidity. In many places, transmission is seasonal, with the peak during and just after the rainy season. The Malaria epidemics can occur when climate and other conditions suddenly favour transmission in areas where people have little or no immunity to malaria. They can also occur when people with low immunity move into areas with intense malaria transmission, for instance to find work, or as refugees.

Malaria is a serious public health problem in most countries of the tropics. Oxidative stress is related to the severity of malaria, oxidative stress in malaria may originate from several sources including intracellular parasitized erythrocytes and extra-erythrocytes as a result of haemolysis and host response. Most treatments primarily target parasites in the blood stage. Loss of appetite and weight loss can occur rapidly. With some types of malaria, the symptoms occur in 48-hour cycles. During these cycles, you feel cold at first with shivering. You then develop a high temperature, accompanied by severe sweating and fatigue. These symptoms usually last between 6 and 12 hours.

Early recognition of warning signs in malarial patients allows timely identification of the patient at risk of severe malaria and provides opportune treatment. Jaundice and dark urine are frequent signs that can alert to the occurrence of severe malaria. Health experts say, the malaria parasite in individuals reports oral symptoms like dry mouth, altered or metallic taste, as well as bitter taste.

There are many health effects of this infection. Malaria can affect vascular pathways that cause inflammation in the heart, which could lead to fibrosis and then heart failure. Leucopenia (reduction in WBCs) is common during acute malaria, whereas leucocytosis (increase in WBCs) can occur during severe malaria. Alterations in WBC count have been associated with severity of infection, concurrent infections and response to treatments. The retinopathy of severe malaria has four main components are retinal whitening, vessel discolouration, haemorrhages, and papilloedema. Cotton wool spots are also seen and are distinct from retinal whitening. The vessel changes and pattern of retinal whitening appear to be unique to this disease. If drugs are not available or if the parasites are resistant to them, malaria infection can develop to anemia, hypoglycemia or cerebral malaria, in which capillaries carrying blood to the brain are blocked. Cerebral malaria can cause coma, life-long-learning disabilities, and death. Focusing on reproductive health, the effect of malaria on semen in an infected male is a myth.

If a mosquito bites a person already infected with malaria, it can also become infected and spread the parasite on to other people. However, malaria can not be spread directly from person to person. Once you're bitten, the parasite enters the bloodstream and travels to the liver. If malaria is diagnosed and treated promptly, virtually everyone will make a full recovery. Treatment should be started as soon as the diagnosis has been confirmed. The most common antimalarial drugs are:

  • Chloroquine phosphate which is the preferred treatment for any parasite that is sensitive to the drug.
  • Artemisinin-based combination therapies (ACTs), a combination of two or more drugs that work against the malaria parasite in different ways.

Malaria is found in more than 100 countries, mainly in tropical regions of the world, including:

  • Large areas of Africa and Asia.
    Central and South America.
  • Haiti and the Dominican Republic.
  • Parts of the Middle East.
    some Pacific islands.

Moreover, African Region continues to carry a disproportionately high share of the global malaria burden. In 2019, the region was home to 94% of all malaria cases and deaths, according to WHO. This is because the majority of infections in Africa are caused by Plasmodium falciparum, the most dangerous of the four human malaria parasites.

Six (6) African nations countries in 2019 accounted for approximately half of all malaria deaths worldwide: Nigeria (23%), the Democratic Republic of the Congo (11%), United Republic of Tanzania (5%), Burkina Faso (4%), Mozambique (4%) and Niger (4% each). WHO states every minute a child dies from malaria in Africa. While under 5 years of age children are the most vulnerable group affected by malaria; in 2019 they accounted for 67% (274 000) of all malaria deaths worldwide.

Even as the COVID-19 pandemic and multiple other crises, 24 countries are reported to have stopped malaria transmission for three or more years by the end of 2020. To date, 38 countries and territories have been certified malaria-free by the World Health Organization, including most recently El Salvador, Algeria and Sri Lanka, according to the United Nations report.

For instance, Botswana and Mozambique benefit from more arid conditions that discourage malaria transmission when compared with other African regions. However, Niger and Senegal rivers in Mali and Senegal, and the Webi Juba and Webi Shabeelie rivers in Somalia, are all potential zones for malaria transmission despite the fact they are outside the geographical zones currently identified as malaria-suitable regions, according to projections of researchers developed while using the new hydrology mapping last year.

In 2020, a study published in Nature Scientific Reports, a team of researchers from Kenya, Ghana and the US say the indiscriminate use of pyrethroid insecticides in agriculture and public health programmes could be responsible for the moderate and high-intensity resistance.

Killing the Killer Malaria

Malaria prevention is through vector control is the main way to prevent and reduce malaria transmission. According to WHO, two forms of vector control: insecticide-treated mosquito nets and indoor residual spraying are effective in a wide range of circumstances. Sleeping under an insecticide-treated net (ITN) can reduce contact between mosquitoes and humans by providing both a physical barrier and an insecticidal effect. Population-wide protection can result from the killing of mosquitoes on a large scale where there is high access and usage of such nets within a community. Antimalarial medicines can also be used to prevent malaria.

Since 2000, progress in malaria control has resulted primarily from expanded access to vector control interventions, particularly in sub-Saharan Africa. However, these gains are threatened by emerging resistance to insecticides among Anopheles mosquitoes. According to the latest World malaria report, 73 countries reported mosquito resistance to at least 1 of the 4 commonly-used insecticide classes in the period 2010-2019. In 28 countries, mosquito resistance was reported to all of the main insecticide classes.

Protecting the efficacy of antimalarial medicines is critical to malaria control and elimination. Regular monitoring of drug efficacy is needed to inform treatment policies in malaria-endemic countries, and to ensure early detection of, and response to, drug resistance. Moreover, effective surveillance is required at all points on the path to malaria elimination. Stronger malaria surveillance systems are urgently needed to enable a timely and effective malaria response in endemic regions, to prevent outbreaks and resurgences, to track progress, and to hold governments and the global malaria community accountable.

But despite many vaccines being trialled over the years, RTS,S/AS01 (RTS,S) is the first vaccines against malaria and, to date, the only vaccine to show that it can significantly reduce malaria, and life-threatening severe malaria, in young African children. When trialled in 450 children in Burkina Faso with over 12 months of follow-up, the vaccine was found to be safe, has shown a preliminary efficacy rate of 77%, which could help prevent over 400,000 deaths a year, most of them in sub-Saharan Africa. Advanced trials in nearly 5,000 children between the ages of five months and three years will now be carried out across four African countries to confirm the results. The vaccine acts against P. falciparum, the most deadly malaria parasite globally and the most prevalent in Africa. Among children who received 4 doses in large-scale clinical trials, the vaccine prevented approximately 4 in 10 cases of malaria over a 4-year period.

Fresh fruits and vegetables work wonders for malaria patients. According to studies, vitamin A and vitamin C rich fruits and vegetables like beetroot, carrot, papaya, sweet lime, grapes, berries, lemon, orange help to detoxify and boost the immunity of the patient suffering from malaria. Mosquitoes that transmit malaria bite between dusk and dawn. Prevent mosquito bites by staying indoors during this time. If out-of-doors, wear a long-sleeved shirt, long pants, and a hat. Apply insect repellent to exposed skin only; do not use under clothing.

During the World Health Assembly in May 2018, the WHO Director-General, Dr Tedros Adhanom Ghebreyesus, called for an aggressive new approach to jump-start progress against malaria. A new country-driven response “ High burden to high impact” was launched in Mozambique in November 2018.

The approach is currently being driven by the 11 countries that carry a high burden of Malaria (Burkina Faso, Cameroon, Democratic Republic of the Congo, Ghana, India, Mali, Mozambique, Niger, Nigeria, Uganda and United Republic of Tanzania). Major elements include:

  • Political will to reduce the toll of malaria;
  • Strategic information to drive impact;
  • Better guidance, policies and strategies; and
  • A coordinated national malaria response.

[embed]https://youtu.be/eDxyYyoW-KM[/embed]

African researchers are trying their best to eradicate malaria from inventing a device to trace parasites without taking out blood samples to modifying drones to spray chemicals and making potions from locally grown plants. A recent survey conducted by the RBM Partnership to End Malaria and Gallup International shows that African youth are determined to end malaria. Conducted across six countries - Kenya, Mozambique, Nigeria, Rwanda, Senegal, and South Africa - the findings reveal that 9 in 10 youth in Africa believe that we can have an impact against the disease.

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